T RAN S C U LT U RAL

NURSING
Guide to Heritage Assessment and
 ⊹ Week 1 -2
“ Review of relevant theories:
Transcultural Nursing Theory
Interpersonal Relations Theory

Cultural Conflicts
2
Contents
⊹Preface
⊹Cultural conflicts
⊹CulturalCare Considerations
•Heritage Assessment
•Cultural Phenomena Affecting HEALTH
•CulturalCare Etiquette
•HEALTH Traditions Assessment Model
•HEALTH Traditions Assessment Guidelines
•Community HEALTH Traditions Assessment Guidelines
⊹CulturalCare Guide
⊹CulturalCare Conclusions
⊹Selected CulturalCare Terms

3
PR E FA
CE

4
 There are countless conflicts that occur in the health-care delivery arenas predicated on
cultural misunderstandings. Albeit, many of these misunderstandings are related to universal
situations, such as:
- verbal and nonverbal language misunderstandings
- the conventions for courtesy
- sequencing of interactions
- phasing of interactions
- Objectivity
There are, however, countless cultural misunderstandings unique to the delivery of health
care; hence the necessity to provide Cultural Care.
5
Cultural Care
⊹ professional health care that is culturally
sensitive, culturally appropriate, and
culturally competent - is essential as we
enter the new millennium, and this
demands that providers must be able to to
assess and interpret the given patient's
health beliefs and practices.

6
CulturalCare alters the perspective of health-care delivery as it enables the provider to
undertand, from a cultural perspective, the manifestations of the patient's HEALTH-CARE
beliefs and practices.

This guides presents:

1. Cultural Conflicts - a sample of clinical situations in which a provider may encounter
situations wherein patients do not adhere to suggested regimens or where other variances in
expected patient behavior occur that may be predictaed on the patient's ethnocultural
heritage.
7
2. CulturalCare Considerations - a selection of practical assessment tools, guidelines, and
information, the purpose of wich is to facilitate communication and caring for the culturally
diverse people you will meet in all practice arenas; and
3. CulturalCare Conclusions - possible solutions to the scenarios posed in the initial section
of this guide. Each of us comes from a unique cultural heritage, and the health-care system in
which we practice may present us with complex cultural dilemmas. As you begin to delve into
this topic, apply each of the tools to yourself and then ask the following questions about your
personal and professional worlds:
• What is my personal ethnocultral heritage and how deeply doI identify with it? 8
• What do I know about HEALTH and illness from my own heritage?
• What is my professional heritage and how deeply do i identfy with it?
• What have I learned about HEALTH in the contexts of both my personal heritage and the
health-care system?

9
 Cultural
1
Conflicts
The following scenarios are composite situations that may be
encountered in a variety of clinical settings. In order to
prevent stereotyping, the heritage of the patient involved in
the situation is not given here. Rather, the situations are
presented in a generic fashion. The tools for assessment and
process are then presented with a subsequent section on
scenario is revisited and the possible “Cultural Care
Conclusions” are presented. They serve to demonstrate how a
given situation may, in fact, occur among people from many
different ethnocultural backgrounds.

11
1. A person who is bleeding refuses surgery when they are
forced to remove what appears to be a piece of jewelry.
2. A person is admitted to the emergency room with welts and
large red circles on their back.
3. A person who is being interviewed refuses to answer
questions directly or to look the provider in the eye.
4. An adult immunization clinic is held in a public building
and the turnout for the program is minimal.
5. A new mother does not want to hold or see her baby
following the delivery.
6. A person on a liquid diet refuses to eat the gelatin.

12
7. A young patient refuses a blood transfusion and is supported
by the family.
8. A patient is given a supply of antibiotics in the emergency
room to treat a respiratory infection and leaves the medication
behind.
9. A person is acurately ill and does not respond to the questions
being asked.
10. A person who is terminally ill is found to have a card hidden
under the pillow.
11. The family of a person who died refuses to lave the room.
12. A patient who is 24-hours post-chest surgery does not
request pain medication.

13
 Culturalcare

consideratio
2
ns
CULTURALCARE
CONSIDERATIONS
This section of the guide contains practical
guides: Heritage Assessment, CulturalCare
Phenomena Affecting HEALTH,
CulturalCare Etiquette, HEALTH
Traditions Assessment Model, and
HEALTH Traditions Assessment
Guidelines for the community.

15
HERITAGE ASSESSMENT TOOL
This set of questions can be used to investigate a given patient's or your own
ethnic, cultural, and religious heritage. it can help you to perform a heritage
assessment to determine how deeply a given person identifies with a particular
tradition. It is most useful in setting the stage for understanding a person's
identification with a traditional heritage. The one exception to positive answers is
the question about family name change. This questions may be answered
negatively.

HERITAGE ASSESSMENT TOOL.docx

16
 CULTURALCARE
PHENOMENA AFFECTIVE
HEALTHC E
Giger and Davidhizar* have identified six cultural phenomena
that vary among cultural groups. These are:
⊹ Environmental ⊹ Biological ⊹ Social
control variations organization

⊹ Communication ⊹ Space ⊹ Time

orientation

17
 Week 3-TOPICS:

Cultural Variations
Cultural Competence
Culturally diverse nursing care
Cultural heritage
Areas/races/places of Variations
 Environmental control
The ability of members of a particular cultural group to
plan activities that control nature or direct environmental
factors. Included are the complex systems of tradional
health and illness beliefs, the practice of folk medicine,
and the use tradional healers. These play an extremely
important role in the way patients respond to health-
related experiences, including the ways in which they
define health and illness and seek and use health-care
resources and social supports.

19
“ ⊹ Cultural Variations call
nurses to be
CULTURALLY
COMPETENT

20
 ⊹ CULTURALLY COMPETENT
1. Gaining understanding of your cultural

“ heritage.
2. Considering how media influences
society’s impressions of cultural groups
3. Developing a general baseline knowledge
relative to specific cultural groups
4. Be vigilant and aware

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 ⊹ CULTURALLY DIVERSE NURSING
CARE

“ It refers to variability in nursing approaches

needed to provide culturally appropriate and
competent care.

Care must be:

1. client-centered
2. Awareness that a culture can and does
influence how clients are viewed and the
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 ⊹ CULTURAL COMPETENCE

“ It is a dynamic, fluid, continuous process

whereby an individual, system or health care
agency finds meaningful and useful care
delivery strategies based on knowledge of the
cultural heritage, beliefs, attitudes and
behaviors of those to whom they render care.

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 ⊹ Cultural Heritage

“ is an expression of the ways of living

developed by a community and passed on
from generation to generation, including
customs, practices, places, objects, artistic
expressions and values. Cultural Heritage is
often expressed as either Intangible or
Tangible Cultural Heritage (ICOMOS, 2002)..

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 BIOLOGICAL
VARIATIONS
People from one cultural group differ
biologically (physically and genetically) from
members of other cultural groups:

a) Body build and structure

b) Skin color

c) Enzymatic and genetic variations

d) Susceptibility to disease

e) Nutritional variations
25
Social organization
The family unit, (nuclear, single-
parent, or extended family) and the
social group organizations (religious
or ethnic) with which patients and
families may identify.

26
COMMUNICATION
Communication differences are presented
in many ways, including language
differences, verbal and nonverbal
behaviors, and silence.

27
Space or proxemics
Personal space and territoriality involves
people’s behaviors and attitudes toward space
around themselves and are influenced by
culture. The following terms indicate different
types of space and relate to acceptable
behaviors within these zones.
a) Intimate zone: extends up to 1 ½ feet.
b) Personal distance: extends from 1 ½ to 4
feet.
c) Social distance: extends from 4 to 12 feet.
d) Public distance: extends 12 feet or more.
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TIME ORIENTATION
The viewing of the time in the present, past, or future varies among different cultural
groups.
a) Future-oriented: People are concerned with long-range goals and with health-care
measures taken in the present to prevent the occurrence of illness in the future.
b) Present-oriented: People are oriented to the present than the future and may be late
for appointments because they are less concerned about planning ahead of time.

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PHENOMENA AFFECTIVE
HEALTHC E
American European
African Asian/Pacific
Indians Hispanic (White)
(Black) Islander
Aleuts, and Americans Origin
Americans Americans
Eskimos Americans

West coast China, Japan, 200 American Hispanic Germany,

(as slaves) of Hawaii, the Indian nations counties England, Italy,
NATIONS OF Africa. Philippines, indigenous to Spain, Cuba, Ireland,
ORIGIN Many African Vietnam, North America Mexico, Former Soviet
countries Asian, India, Aleuts, and Central and Union, and all
West Indian Korea, Eskimos in South America other
islands Samoa, Alaska Puerto Rico European
Dominican Guam, and countries
Republic the remaining
Haiti Asian/pacific
Jamaica islands

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PHENOMENA AFFECTIVE
HEALTHC E
Asian/Pacific American European
African (Black) Hispanic
Islander Indians Aleuts, (White) Origin
Americans Americans
Americans and Eskimos Americans

Traditional health Traditional health Traditional health Traditional health Primary reliance
and illness and illness and illness and illness on “modern,
beliefs may beliefs may beliefs may beliefs may Western”
continue to be continue to be continue to be continue to be healthcare
observe by observe by observe by observe by delivery system
ENVIRONMENT “traditional ” “traditional ” “traditional ” “traditional ” Remaining
-AL CONTROL people people people people traditional health
Natural and Folk medicine and illness
magicoreligious tradition beliefs and
folk medicine Traditional practices may be
tradition healers: observed
Traditional curandero, Some remaining
healer: medicine espirista, traditional folk
man or woman partera, señora medicine
Homeopathic
medicine
resurgent
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PHENOMENA AFFECTIVE
HEALTHC E
American European
African Asian/Pacific
Indians Hispanic (White)
(Black) Islander
Aleuts, and Americans Origin
Americans Americans
Eskimos Americans

• Sickle cell • Hypertensi • Accidents • Diabetes • Breast

anemia on • Heart mellitus cancer
• Hypertensi • Liver disease • Parasites • Heart
BIOLOGICAL on cancer • Cirrhosis • Coccidioid disease
VARIATIONS • Cancer of • Stomach of the liver omycosis • Diabetes
the cancer • Diabetes • Lactose mellitus
esophagus • Coccidioid mellitus intolerance • Thalassem
• Stomach omycosis ia
cancer • Lactose
• Coccidioid intolerance
omycosis • Thalassem
• Lactose ia
intolerance

32
PHENOMENA AFFECTIVE
HEALTHC
American European
African Asian/Pacific
Indians Hispanic (White)
(Black) Islander
Aleuts, and Americans Origin
Americans Americans
Eskimos Americans

Family: many Family: Extremely Nuclear Nuclear

single-parent hierarchical family-oriented families families
Female-headed structure, loyalty to both Large, Extended
household Large, extended biological and extended family families
SOCIAL Large, family networks extended networks Judeo-Christian
ORGANIZATI extended family Devotion to families Compadrazzo religions
ON networks traditional Children are (godparents) Community
Strong church Many religious, taught to Strong church social
affiliations including respect affiliations organizations
within Taoism, traditions within
Buddhism,
community Community community
Islam, and
Community social Community
Christianity
social Community organizations social
organizations social organizations
organization
33
PHENOMENA AFFECTIVE
HEALTHC E
American European
African Asian/Pacific
Indians Hispanic (White)
(Black) Islander
Aleuts, and Americans Origin
Americans Americans
Eskimos Americans

National National Tribal Spanish or National

languages: language languages Portuguese are languages
Pidgin French, preference Use of silence the primary Many learned
Spanish, Dialects, and body languages English rapidly
Creole written language as immigrants
COMMUNICA Verbal, rather
TION characters
than nonverbal
Use of silence
Nonverbal and
contextual
cueing

34
PHENOMENA AFFECTIVE
HEALTHC E
American European
African Asian/Pacific
Indians Hispanic (White)
(Black) Islander
Aleuts, and Americans Origin
Americans Americans
Eskimos Americans
Space Close Noncontact Space very Tactile Noncontact
personal people important and relationships: people: aloof,
space has no touch, distant
boundaries handshakes, Southern
embrace countries:
Values closer contact
physical and touch
presence

Time Present over Present Present Present Future over

orientation future present

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RE
ETIQUETTE
There are countless ways in which the
etiquette essential to a satisfactory
provider-patient encounter is breached.
This table presents an overview of
selected situations wherein etiquette
can be modified to the needs of a
patient.
CULTURAL PHENOMENA AFFECT
ING ETIQUETTE.docx

36
HEALTH TRADITIONS
ASSESSMENT MODEL
People who identify with a traditional ethnocultural heritage may tend to define HEALTH
and illness in a holistic way, and have health beliefs and practices that differ from those of
the Western, or modern, health-care delivery system.
Imagine holistic HEALTH as a three-dimensional phenomenon that encompasses the
following: body (the physical self), mind (feelings, attitudes, and behavior), and spirit (the I
am who I am).
HEALTH, in the traditional sense, is the state of balance within the body, mind, and
spirit, and with the family, community, and the forces of the natural world.
Illness is the opposite.
Many traditional HEALTH beliefs and practices exist today among people who know
and live by the traditions of their given ethnocultural heritage.
37
HEALTH TRADITIONS
ASSESSMENT MODEL
HEALTH, in this traditional context, has three dimensions each of which has three aspects,
making a total of nine interrelated facets.

1. Maintaining HEALTH

a) Physical- are there special clothes one must wear; food one must eat, not eat, or
combinations to avoid; exercises one must do?

b) Mental- are there special sources of entertainment; games or other ways of concentrating;
traditional “rules of behavior”?

c) Spiritual- are there special religious customs; prayers; meditations?

38
HEALTH TRADITIONS
ASSESSMENT MODEL
2. Protecting HEALTH
a) Physical- are there special foods that must be eaten after
certain life events, such as childbirth; dietary taboos that
must be adhered to; symbolic clothes that must be worn?

b) Mental- are there special people who must be avoided;

rituals for self-protection; familial roles?

c) Spiritual- are there special religious customs; superstitions;

amulets; oils or waters?

39
HEALTH TRADITIONS
ASSESSMENT MODEL
3. Restoring HEALTH
a) Physical- are there special folk remedies; liniments; procedures, such as cupping,
acupuncture, and moxibustion?

b) Mental- are there special healers, such as curanderos, available; rituals; folk medicines?

c) Spiritual- are there special rituals and prayers; medications; healers?

Traditional methods of maintaining, protecting, and restoring HEALTH require the

knowledge and understanding of HEALTH-related resources from within a given person’s
ethnoreligious cultural heritage and community. These methods may be used instead of or
along with modern methods of health care. They are not alternative methods or health care
in the sense that they are methods that are an integral part of a person’s given heritage.
40
HEALTH TRADITIONS
ASSESSMENT GUIDELINES
A given patient’s interrelated HEALTH traditions can be assessed
in countless ways. The following grids contain suggested
questions and are parallel to the nine interrelated facets of
HEALTH (the physical, mental, and spiritual) aspects of the
personal and communal dimensions of maintaining, protecting
and restoring HEALTH that are a theme throughput Cultural
Diversity in Health and Illness and this assessment guide.

41
HEALTH TRADITIONS
ASSESSMENT MODEL
PHYSICAL MENTAL SPIRITUAL

Maintain • Are there special • What do your do for • Do you practice you
clothes you must wear activities, such as religions and attend
HEALTH at certain times of the reading, sports, church or other
day, week, year? games? communal activities?
• Are there special • Do you have • Do you pray or
foods you must eat at hobbies? meditate?
certain times? • Do you visit family • Do you observe
• Do you have any often? religious customs?
dietary restrictions? • Do you visit friends • Do you belong to
• Are there any foods often? fraternal
that you cannot eat? organizations?

42
HEALTH TRADITIONS
ASSESSMENT MODEL
PHYSICAL MENTAL SPIRITUAL

Protect • Are there foods that • Are there people or • Do you observe
you cannot eat situations that you religious customs?
HEALTH together? have been taught to • Do you wear any
• Are there special avoid? amulets or hang them
foods that your must • Do you take in your home?
eat? extraordinary • Do you have any
• Are there any types of precautions under practices, such as
clothing that you are certain always opening the
not allowed to wear? circumstances? window when you
• Do you take time for sleep?
yourself? • Do you have any other
practices to protect
yourself from “harm”?

43
HEALTH TRADITIONS
ASSESSMENT MODEL
PHYSICAL MENTAL SPIRITUAL

Restore • What kind of • Do you know of any • Do you know of any

medicines do you take specific practices religious rituals that
HEALTH before you see a your mother or help to restore health?
doctor or nurse? grandmother may • Do you meditate?
• Are there herbs that use to relax? • Did you ever go to a
you take? • Do you know how healing service?
• Are there special big problems can be • Do you know about
treatments that you cared for in your exorcism?
use? community?
• Do you drink special
teas to help you
unwind or relax?
• Do you know of any
healers?

44
COMMUNITY HEALTH
TRADITIONS ASSESSMENT
GUIDELINES
HEALTH traditions come alive the moment one leaves institutional confines and goes into the
community. An in-depth community assessment of an ethnoreligious community alerts your to
the vast resources that exist within traditional communities and that may be tapped.
The following outline serves as a community assessment guide:
Demographic Data
⊹ Total population size of entire city or town
⊹ Breakdown by areas – residential concentrations
⊹ Breakdown by ages
⊹ Other breakdowns: Educations, occupations, income and nations of origin of
residents of the location and the target neighborhood
45
TRADITIONS ASSESSMENT
GUIDELINES
Traditional HEALTH Beliefs: Definition of HEALTH; Definition of illness;
Overall HEALTH status

Causes of Illness: Poor eating habits; wrong food combinations; viruses, bacteria,
and other organisms; punishment from God; the eye evil; hexes, spells or envy;
witchcraft; environmental changes; exposure to drafts; over- or underwork; grief
and loss

46
 TRADITIONS
ASSESSMENT
GUIDELINES
- Methods of Maintaining HEALTH
- Methods of Protecting HEALTH
- Methods of Restoring HEALTH – Home Remedies
- Visits and Use of M.D. or Other Health-Care Resources
- HealthCare Resources, Such as Neighborhood health Centers
- Anyone Else Within Community Who Looks After People, Such As
Traditional Healers
- Child-Bearing Beliefs and Practices
- Child-Rearing Beliefs and Practices
- Rituals and Beliefs Surrounding Death and Dying
47
 TRADITIONS
ASSESSMENT
GUIDELINES
Walk through the community and observe the traditional grocery
stores, pharmacies, markets, jewelry stores, beauty parlors,
morticians, and churches. If possible, visit several places, purchase
remedies, eat in a restaurant, and observe services in a church.

48
ASSESSMENT GUIDE FOR COMMUNAL
METHODS AND RESOURCES FRO MAINTAING,
PROTECTING, AND RESTORING HEALTH
PHYSICAL MENTAL SPIRITUAL
Maintain • Where are people • What are examples • Are these resources
HEALTH able to purchase of culture-specific to meet the patient’s
special clothing? books, games, and identified spiritual
• Where are specific other activities for needs?
foods purchased? this given patient? • How are the people
• What types of health • Where are books, and places
education are a part games, and other accessed?
of the person’s forms of culture-
culture and who specific materials
teaches this obtained?
information? • What are culture-
• Where is the specific rules for
information this patient, such
obtained? as conversation,
eye contact?

49
HEALTH TRADITIONS
ASSESSMENT MODEL
PHYSICAL MENTAL SPIRITUAL

Protect • Where are special • Who within the • Who teaches the
HEALTH clothes obtained? patient’s family spiritual practices?
• What are some and community • Where can the
examples of teaches the patient purchase
symbolic clothing a cultural rules? special amulets and
person may obtain? • Are there rules other symbolic
about avoiding objects?
people or places? • Are they costly?
• Are there special • Are they readily
activities that available?
must be
observed?

50
HEALTH TRADITIONS
ASSESSMENT MODEL
PHYSICAL MENTAL SPIRITUAL

Restore • Where are various • Who are the • Are the traditional
remedies purchased? traditional people healers in the
HEALTH • Are people able to within the community?
grow herbs and other community that the • Who are they and how
remedies in their own person may seek are they accessed?
homes? care and advice
• Where are other from?
traditional services • Are there culture-
obtained? specific activities,
• Who are the such as story telling
traditional healers that may be
within the patient available to the
community and where patient?
do they practice? • Where are the
ingredients for
special “teas”
purchased?
51
Selected
SELECTED HEALTH TRAD
health ITIONS.docx

traditions

52
 Culturalcare
3
guide
The following guidelines will help you understand your patients better and allow you to
provide the needed help.

Preparing
⊹ Understand your own cultural values and biases.
⊹ Acquire basic knowledge of cultural values, HEALTH beliefs and practices for the
patient groups you serve.
⊹ Be respectful of, interested in, and understanding of other
cultures without being judgmental.

54
Enhancing Communication
⊹ Determine the patient’s level of fluency in English and arrange for an
interpreter, if needed.
⊹ Ask how the patient prefers to be addressed.
⊹ Allow the patient to choose seating for comfortable personal space and eye
contact.
⊹ Avoid body language that may be offensive or misunderstood.
⊹ Speak directly to the patient, whether an interpreter is present or not.
⊹ Choose a speech rate and style that promotes understanding and
demonstrates respect for the patient.
⊹ Avoid slang, technical jargon, and complex sentences.
⊹ Use open-ended questions or questions phrased in several ways to obtain
information.
⊹ Determine the patient’s reading ability before using written materials in the
teaching process. If patient cannot read English, translate materials.
55
Promoting Positive Change
• Build on cultural practices, reinforcing those that
are positive, and promoting change only in those
that are harmful.
• Check for patient understanding and acceptance
of recommendations.
• Remember: Not all seeds of knowledge fall into
a fertile environment to produce change. Of
those that do some will take years to germinate.
Be patient and provide care in a culturally
appropriate environment to promote health
behavior.

56
 Culturalcare

CONCLUSI
3
ONS
 Each of the cases presented in the beginning of
this guide book can be understood if viewed through a
lens of CulturalCare. Initially, the patient in each scene
must be assessed with the Heritage Assessment tool.
Once the given patient’s ethnocultural history is
learned and the degree to which this person identifies
with the given tradition detected, emphasis must be
placed on discovering the role given heritage plays in
the situation. Each situation has specifi reasons for
occurring within a cultural context. The text, Cultural
Diversity in Health and Illness, 5th ed., provides a
much deeper theoretical background relevant to each
of the situation. A summary is presented here:
⊹ A person who is bleeding refuses surgery when they are forced to remove what appears
to be a piece of jewelry.
This person may be from an ethnocultural tradition where amulets are worn and the
removal. Of the amulet may precede certain health death. The amulet is believed to
protect the person from external evils and thee person may be reluctant to remove it
for this reason. The person may be from an African, Hispanic, Asian, or European
heritage.
⊹ A person admitted to the emergency room with welts and large red circles on their back.
The person may come from an ethnocultural tradition where coining or cupping are
used to treat many maladies, especially respiratory infections. These traditional
practices include people from Asian and Eastern heritage.

59
⊹ A person who is being interviewed refuses to answer questions directly or to look the
provider in the eye.
The person may come from an ethnocultural tradition that places taboo on
interviews where the recording of answers Is taboo and/or eye contact with strangers
is prohibited. The heritages may include, but are not limited to, American Indian,
African American, and Moslem.
⊹ An adult immunization clinic is held in a public building and the turnout for the program
is minimal.
The person may come from an ethnocultural tradition wherein it is believed that
immunization is not necessary for adult, especially the elderly. Many believe that
since they were not immunized as children, it is necessary now. Others believe that
seit, amulets, and other practices serve to protect their HEALTH. This phenomena
may be observed among people from all heritages.
60
⊹ A new mother does not want to hold or see her baby following the delivery.
The person may come from an ethnocultural tradition where she has been socialized
to believe that the baby must not be bonded with until it is a certain age, as it is
vulnerable to outside evil forces. Many rituals of a religious or ethnocultural nature
must be observed until the baby is seen to be free from a state of taboo and then
bonding is permissible. This may be observed among people from Middle Eastern
countries. Also, it may be observed that the mother, or grandmother, may place a red
ribbon on the baby.
⊹ A person on a liquid diet refuses to eat the gelatin.
The person may come from an ethnocultural tradition that prohibits the eating of pig
and/or animal products and gelatin is made from pig bones, unless specified as
“kosher”. Jews and Muslims who follow the kosher diet may reject this food.

61
⊹ A young patient refuses a blood transfusion and is supported by the family.
The person may come from an ethnocultural tradition that prohibits the use of blood. This
is especially seen when caring for Jehovah’s Witnesses, but other religions also prohibit
the use of blood.
⊹ A patient is given a supply of antibiotics in the emergency room to treat a respiratory infection
and leaves the medication behind.
The person may come from an ethnocultural tradition that rejects the use of Western
medications. The person may elect to use traditional medications and seek the services of
a traditional herbalist. This is observed among Hispanics and Asian Americans.
⊹ A person is acutely ill and does not respond to the questions being asked.
The person may come from an ethnocultural tradition that views the answering of direct
questions to be taboo. The given person may prefer to answer questions that are asked
indirectly and where metaphors are used as statements. This practice is found among
American Indians 62
⊹ A person who is terminally ill is found to have a card hidden under the pillow.
The person may come from an ethnocultural tradition that views the answering of direct
questions to be taboo. The given person may prefer to answer questions that are asked
indirectly and where metaphors are used as statements. This practice is found among
American Indians.
⊹ The family of a person who died refuses to leave the room.
The family of the recently decreased person may come from an ethnocultural tradition that
believes that the soul of the person must be protected and the body must be ritually cared
for by members of the family and/or religious community.
⊹ A patient who is 24-hours post-chest surgery does not request pain medication.
The person may come from an ethnocultural tradition that believe in “saving face” and
that to complain of pain is taboo. This belief is particularly common among Chinese
people.
63
 Needless to say, even with these brief scenarios and
explanations there is the danger of stereotyping.
However, the situations are real – they occurred within
the scope of my own practice and experiences. When
situations such as these occur, the most important
aspect of care is to have the “cultural” antenna sharp
and to question the patient, the family, and/or
community people to determine the ethos of the
patient’s cultural beliefs and practices. In this way, a
proper way can be found to avoid harming the patient
and holding respect for the patient’s cultural traditions.
64
 Selected
Culturalcare
3
terms
 CulturalCare – A concept that describes professional health care that is
culturally sensitive, culturally appropriate, and culturally competent.
 Culturally appropriate – implies that the health-care provider applies the
underlying background knowledge that must be possessed to provide a given
patient with the best possible health care
 Culturally competent – implies that within the delivered care the health-care
provider understands and attends to the total context of the patient’s situations
including awareness of immigration, stress factors, and cultural differences.
 Culturally sensitive – implies that the health-care providers possess some basic
knowledge of and constructive attitudes towards the diverse cultural groups found
in the setting in which they are practicing.
 Emerging Majority – people of color-Black; Asian or Pacific Islander; American
Indian, Eskimo, or Aleut; and Hispanic origin, who are expected to comprise a
majority of the American population by the year 2020.
 HEALTH – the balance of the person, both within one’s being–physical, mental,
and spiritual–and one in the outside environment–natural, familial, and
communal, and metaphysical. 66
 HEALTH maintenance – the traditional beliefs and practices,
such as daily health-related activities, diet, exercise, rest, and
clothing, used to maintain HEALTH.
 HEALTH protection – the traditional beliefs and practices
about what should be done on special occasions or on an
ongoing basis for HEALTH protection, such as food taboos
and wearing amulets.
 HEALTH restoration – the traditional beliefs and practices
concerning the activities, such as the use of folk remedies and
healers, that must be used to restore HEALTH.

67
Sample Grid for Cultural Health Assessment
Physical Mental Spiritual

Maintain
HEALTH
Protect
HEALTH
Restore
HEALTH

68
Thank you for
listening! 69